You can find a lot of information on the web about plantar fasciitis and other foot problems. The causes most commonly found in your online searches is:
- You have high arches or flat feet – (I see plenty of people with both high arches or flat without foot problems)
- You walk or stand for long periods on hard surfaces – (possible, but many people do this without problems).
- You’re overweight – (Possible. Extra weight does put more stress on the arch of the foot)
- You wear shoes that don’t fit well or are worn out – (We’re getting on the right track now)
- You have tight achilles tendons or calf muscles – (Those issues can play a role, but it’s typically not the cause)
In the 8 years that I have been treating plantar fasciitis, and other problems that result in pain in the bottom of the feet, I do not find the causes above as the primary reasons so many people are getting plantar fasciitis and foot pain.
The culprit is shoes!
Shoes are the reason there is an epidemic of foot problems.
When we wear shoes, we are effectively putting our feet into a cast. Most people wear shoes that match their foot size. So, if you have a size 8 foot, you probably wear a size 8 shoe. That means that your shoes probably fit your feet kind of snug. This renders the many joints of the foot somewhat immobile. Couple that with a relatively stiff sole, and the sides, top, and bottom of your feet are relegated immobile. Not 100% immobile, but at least 50% less mobility, if not 70%. That’s a huge decrease in the range of motion of the many joints within the foot. This results in stiffness and tightness within the soft tissue and joints, and over the long term it results in foot problems and foot pain.
Shoes also change the geometry of the foot over the long term. Virtually all of the shoes we wear have a narrow toe box. Men’s dress shoes and women’s high heels especially have narrow toes boxes. After wearing these types of shoes for many years, the shape of the foot begins to match the shape of the shoe.
Healthy feet tend to have more of a triangular geometry…
while many unhealthy feet have more of a diamond shaped geometry…
The diamond shape is a result of the narrow tow box forcing the big toe inward toward the toe next to it, and forcing the baby toe inward toward the toe next to it. (See photo).
Shoes also weaken the muscles in the bottom of the feet. Because most shoes tend to have an arch support built into them, the arch built into the shoe is what supports the arch of the foot, instead of the foot muscles. There are 22 muscles in the bottom of the foot. When they constantly have arch support, the plantar muscles in the bottom of the foot become weak. When they become weak they don’t hold the arch up, and the arch of the foot begins to be lost and becomes flatter. You would think the built in arch supports of the shoes would resolve this problem, but that’s not how it works. You arch eventually settles more into a shallow arch, because the weak muscles let the arch settle on the arch within the shoes, which is always lower than the actually arch within the bones of your feet.
So then what happens is your nervous system says, “Well! These muscles aren’t being used enough, and they’re getting weak, so let’s tighten those muscles up to provide more stability for the arch.” By tightening the muscles in the bottom of the foot, it’s the nervous systems way of attempting to maintain an arch that is supported by weak plantar muscles.
But the development of dysfunction doesn’t stop there.
Your foot is one of the most nerve rich areas of your body. Per square centimeter, there is an abundance of receptors in the bottom of the foot that monitor pressure, vibration, stretch or strain, shear, temperature, and pain. All of these receptors are supposed to receive input from the ground, but the problem is that the bottom of our foot is covered with a 1/2″ soft sole that dampens and absorbs most of the input. All of these receptors are embedded within the soft tissue of the bottom of the foot. So, we have plantar muscles that are weak, skeletal geometry that is being distorted by the shape of the shoe, and nerve receptors that are not receiving the input they are supposed to receive. Shoes are a recipe for eventual foot problems.
So how do we fix this problem in a culture where shoes are worn 12 or more hours per day?
You need to start thinking about working out your feet just like you work out the rest of your body. You go to the gym or a boot camp to develop bigger shoulders, or stronger glutes, but have you ever worked out the 22 muscles in the bottom of your feet?
We have to think of working out the muscles of our feet too.
Here is what you can do:
- Walk barefooted as often as you can. The best way to strengthen the muscles in the bottom of the foot is to strengthen them by walking or running barefoot. However, walking around your apartment barefooted doesn’t count. You have to walk on firm surfaces like a high school or community college track. You can definitely walk on pavement, but that’s actually something you have to work up to. High school or community college tracks are usually made of rubber. The rubber is somewhat forgiving on the bottom of the feet, but firm enough to get the muscles contracting better.
- Walking barefoot also exposes all of the receptors I talked about above to stimulation. When you walk barefoot, all of those pressure receptors, vibration receptors, stretch receptors, and temperature receptors are awoken. That direct contact with the surface of the ground, especially when walking, results in a lot of input. This input results in a re-syncronicity between the muscles (soft tissue) and the nerve receptors.
- I prefer you go barefoot to rehab your feet, but you can also wear minimal shoes. A minimal shoe with a 3mm sole is about the maximum sole thickness I would want you to wear. 3mm results in a lot of input received by the receptors of the foot.
- When you go to the gym or you go to your bootcamp, wear your minimal shoes. Think of working out your foot muscles like you think about working out your biceps. They need to become a priority. Boot camps tend to include a lot of movements like lunges, jumps, and other exercises that require balance and the use of muscles in the bottom of the feet more intensely. Do a boot camp barefoot or in minimal shoes. If you just go to the gym to lift weights, you should still wear your minimal shoes. I need you to get as much contraction of the foot muscles as possible.
- Another great thing to do is go to the beach and walk and/or run on the sand; especially the loose dry sand. Sand is unstable and moves a lot beneath your feet. The unstable nature of sand requires you to flex your toes more as you run or walk to grip the sand for more stability.
- A stability disc is a nice thing to have at home if you don’t have the time to go to the beach or hit the local track. Balance on one foot on a stability disc and focus on gripping your toes into the disc. This results in a nice workout for the muscles in the bottom of the foot.